MEDICARE: DR. CHUL SUNG KANG LAC , OMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC8770	CA

General Provider Information

NPI Number	:	1992878631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUL SUNG KANG LAC , OMD

Provider Business Mailing Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	460
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-739-0330
Fax Number	:	213-383-5516

Provider Business Practice Location Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	460
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-739-0330
Fax Number	:	213-383-5516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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